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Chin-Tse L, Meng-Chen T, Shih-Lun C. Adult False Vocal Cord Cavernous Lymphangioma Presenting with Hemoptysis: A Case Report. EAR, NOSE & THROAT JOURNAL 2024; 103:NP321-NP324. [PMID: 34802262 DOI: 10.1177/01455613211047131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lymphangiomas are rare benign tumors of the lymphatic system, most often found at birth and before the age of 2 years. The head and neck region are the most frequent locations for lymphangioma. Involvement of the adult larynx in isolation is rare, and only a few cases have been reported so far. We report the case of a patient with a left false vocal cord reddish tumor presenting with hemoptysis and voice cracking. The surgical excision of mass was performed by direct laryngoscopy-assisted CO2 laser. The histopathological report revealed the diagnosis as cavernous lymphangioma. After a follow-up of 1 year, the patient is free of recurrence with all laryngeal functions being normal.
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Affiliation(s)
- Lee Chin-Tse
- Department of Otorhinolaryngology, Chi Mei Medical Center, Tainan, Taiwan
| | - Tsai Meng-Chen
- Pathology Center, Chi Mei Medical Center, Tainan, Taiwan
| | - Chang Shih-Lun
- Department of Otorhinolaryngology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
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2
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Shabbir F, Rashid M, Khan MI, Sarwar SUR, Khan AH, Goher M. Our Experience in the Surgical Management of Arterio-Venous Malformations of the head and neck. JPRAS Open 2024; 40:59-67. [PMID: 38434943 PMCID: PMC10907505 DOI: 10.1016/j.jpra.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/07/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Vascular anomalies comprise a diverse group of abnormalities in blood vessel morphogenesis that usually occur prenatally. Arterio-venous malformations (AVMs) are rare congenital vascular lesions accounting for 1.5% of all vascular anomalies, with 50% of them occur in the oral and maxillo-facial regions. Treatment of large, complex vascular lesions is a serious challenge for patients and surgeons because it can cause disfigurement and massive haemorrhage, which may be spontaneous or the result of surgical intervention. Our study aimed to demonstrate surgical management of massive AVMs of the head and neck. Method This retrospective study shows the treatment outcomes of 28 patients with massive maxillo-facial vascular malformations, who presented to our department for treatment from 1 January 2015 to 31 July 2022. Results Twenty-eight patients with a mean age of 17.32 ± 12.21 years (women: 15, men: 13) were enrolled in the study. Diagnosis included extra cranial AVMs of the head and neck region. Treatment modalities, in isolation or combination, included angioembolisation procedure, sclerotherapy, and surgery. Conclusion Management of AVMs is challenging owing to the replacement of normal tissue by the diseased ones and the high rate of recurrence. Hence, multi-modal approaches are needed for the effective restoration of tissues.
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Affiliation(s)
- Farwa Shabbir
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Mamoon Rashid
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - M. Ibrahim Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Saad ur Rehman Sarwar
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Adeela Hussain Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Maimoona Goher
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
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3
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Fiore M, Bortoli M, Sambri A, Lotrecchiano L, Lovato L, Mirelli M, Neri I, De Paolis M, Piraccini BM, Gargiulo M. Soft Tissue Vascular Anomalies of the Extremities: A Proposed Diagnostic Approach. Life (Basel) 2024; 14:670. [PMID: 38929654 PMCID: PMC11204615 DOI: 10.3390/life14060670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues.
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Affiliation(s)
- Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Ludovica Lotrecchiano
- Oncoematologic and Emergencies Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.L.); (L.L.)
| | - Luigi Lovato
- Oncoematologic and Emergencies Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.L.); (L.L.)
| | - Michele Mirelli
- IRCCS, Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.F.); (M.B.); (M.D.P.)
| | - Bianca Maria Piraccini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Mauro Gargiulo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (B.M.P.); (M.G.)
- IRCCS, Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Kerr AM, Bereitschaft C, Sisk B. The role of primary care in rare disorders: A qualitative study of parents and patients managing complex vascular anomalies. J Family Med Prim Care 2024; 13:2116-2122. [PMID: 38948545 PMCID: PMC11213429 DOI: 10.4103/jfmpc.jfmpc_1556_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/05/2023] [Accepted: 01/10/2024] [Indexed: 07/02/2024] Open
Abstract
Background Patients with complex rare disorders often require the care of multiple specialists. Effective coordination between primary and specialty care is needed to ensure patients receive high-quality care. Previous research has documented the importance of primary care clinicians providing referrals to specialty care and the importance of specialists in helping patients reach a diagnosis. However, little is known about primary care clinicians' roles in the ongoing care of patients with rare disorders. In the current study, we explored the role of primary care clinicians in the care of rare and complex vascular anomalies. Materials and Methods Data were collected using semi-structured qualitative interviews with 34 parents and 25 adult patients recruited from advocacy groups for patients with complex vascular anomalies participated. We asked participants about their diagnosis, care experiences, and communication with clinicians. We used thematic analysis to identify themes illustrating the roles of primary care clinicians. Results PCC roles were characterized by four behaviors. Supporting behaviors included learning more about vascular anomalies and asking participants about the care they received from specialists. Facilitating included providing referrals, ordering tests, and engaging in problem-solving. Interfering included failing to provide referrals or help participants coordinate care, ordering incorrect tests, or making inappropriate recommendations. Disregarding included focusing narrowly on primary care needs and not showing concern about the vascular anomaly. Conclusions The results reveal opportunities to improve primary care for patients with vascular anomalies. Disregarding and interfering behaviors furthered the division between primary and specialty care for patients with vascular anomalies and prevented patients from receiving comprehensive primary care. Supporting and facilitating behaviors convey genuine interest in the care of the vascular anomaly and a commitment to helping the patient and parent.
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Affiliation(s)
- Anna M. Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio, U.S.A
| | - Christine Bereitschaft
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Bryan Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
- Department of Medicine, Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Ghosn Y, Jabbour Y, Zeid FA, Jurdi N, Khouzami R, Moukaddam H. Massive spinal epidural infantile hemangioma, image findings, and treatment: a case report and review of literature. Skeletal Radiol 2024:10.1007/s00256-024-04570-1. [PMID: 38512366 DOI: 10.1007/s00256-024-04570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024]
Abstract
Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Farah Abou Zeid
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Nawaf Jurdi
- Department of Pathology, American University of Beirut, Beirut, Lebanon
| | - Riad Khouzami
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon.
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Sisk B, Lin S, Kerr AM. Factors affecting the ability of patients with complex vascular anomalies to navigate the healthcare system. Orphanet J Rare Dis 2024; 19:18. [PMID: 38238812 PMCID: PMC10797881 DOI: 10.1186/s13023-024-03018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Vascular anomalies (VAs) are rare congenital disorders that can cause pain, disfigurement, coagulopathy, asymmetric growth, and disability. Patients with complex VAs experience multiple barriers to accessing expert care. It is imperative to understand which factors support these patients' ability to navigate the healthcare system. RESULTS We surveyed adult patients with VAs using previously validated measures, recruiting participants from five patient advocacy groups and multidisciplinary VA clinics. The primary outcome was self-reported ability to access needed medical care, using the "Navigating the Healthcare System" subscale of the Health Literacy Questionnaire. We evaluated factors associated with the ability to navigate the healthcare system using multivariate linear regression (n = 136). We also performed an exploratory model that included the primary care doctor's knowledge of VAs for the subset of participants with a primary care doctor (n = 114). Participants were predominantly women (n = 90, 66%), White and non-Hispanic (n = 109, 73%), and college-educated (n = 101, 73%). Most participants had PIK3CA-Related Overgrowth Spectrum (n = 107, 78%). Most participants reported that navigating the healthcare system was "sometimes" or "usually difficult" (mean score 16.4/30, standard deviation 5.6). In multivariate linear regression, ability to navigate the healthcare system was associated positively with quality of information exchange (β = 0.38, 95% Confidence Interval (CI) 0.22 to 0.55, p <.001) and whether patients had VA specialists (β = 2.31, 95% CI 0.35 to 4.28, p =.021), but not associated with patient self-advocacy, anxiety, education, age, race and ethnicity, gender, or having a primary care doctor. In exploratory analysis of participants with primary care doctors, ability to navigate the healthcare system was positively associated with quality of information exchange (β = 0.27, 95% CI 0.09 to 0.45, p =.004), having a VA specialist (β = 2.31, 95% CI 0.22 to 4.39, p =.031), and primary care doctors' VA knowledge (β = 0.27, 95% CI 0.04 to 0.50, p =.023). CONCLUSION Patients with VAs struggle to navigate the healthcare system. High-quality information from clinicians and more knowledgeable primary care doctors might help patients to access needed care. Relying on patient self-advocacy is insufficient. Future efforts should focus on patient-directed and clinician-directed educational interventions. Additionally, future work should assess the structural barriers that impede healthcare access for these patients.
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Affiliation(s)
- Bryan Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Sunny Lin
- Informatics Institute, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
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Chrysouli K, Karamagkiolas S. Venous malformation phleboliths mimicking submandibular sialadenitis in children. BMJ Case Rep 2023; 16:e257971. [PMID: 38087492 PMCID: PMC10728921 DOI: 10.1136/bcr-2023-257971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
To report one paediatric patient who presented with a rare venous vascular malformation as a mass in the left submandibular region with a clinical picture compatible with sialadenitis. Phleboliths are a specific feature of venous malformations due to venous stasis and may mimic sialoliths on various imaging modalities. Thus venous malformations are often misdiagnosed as sialadenitis due to sialolithiasis. Sialoliths are extremely rare in paediatric patients. In an early adolescent presenting with a submandibular mass and suspected sialadenitis arising from sialoliths, a detailed history, clinical examination and careful review of the radiological findings will allow the diagnosis of venous vascular malformation and provide the complete surgical resection. Our patient was initially referred with a presumed diagnosis of submandibular sialadenitis, and instead a venous malformation with phlebolith was diagnosed.
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Affiliation(s)
| | - Sotirios Karamagkiolas
- Department of Otorhinolaryngology, Panepistemiako Geniko Nosokomeio Attikon, Athens, Attica, Greece
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8
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Nwoga MC. Benign Orofacial Vascular Anomalies: Review of 47 Cases in Enugu, Nigeria. Niger J Clin Pract 2023; 26:1723-1727. [PMID: 38044779 DOI: 10.4103/njcp.njcp_332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/01/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND A study of oral vascular anomalies has not been conducted in Nigeria to provide baseline data for comparison with reports in the literature. AIMS To study the prevalence and distribution of benign orofacial vascular anomalies at a tertiary hospital in Enugu. MATERIALS AND METHODS This is a 10-year retrospective observational study of consecutive patients with orofacial vascular anomalies, diagnosed by histology. The clinic-pathologic information was obtained from records archived in the department, and descriptive analysis was used to determine the frequency, tables for categorical variables, and a Chi-square test to determine the statistical significance. RESULT There were 47 cases of benign vascular anomalies out of 897 orofacial lesions giving a prevalence of 5.2%. There were 35.4% (17) male and 64.6% (31) female patients. The mean age in this series was 37.4 ± 19.8 (range: 1 to 76 years). Pyogenic granuloma was the most common vascular lesion 78.7% (37), followed by hemangioma 14.9% (7) and lymphangioma 6.4% (3). The gingiva was the most frequent site of oral occurrence 65.9% (31), especially maxillary gingivae 48.9% (23). The type of orofacial vascular anomalies was significantly associated with the anatomical site of occurrence, P = 0.00. The mean ages for the occurrence of pyogenic granuloma, hemangioma, and lymphangioma were 37.7 ± 18.3, 50.7 ± 16.9 years, and 3.3 ± 3.2 years, respectively. Pain was a frequent occurrence in 36.2% (17) of anomalies. CONCLUSION Oral vascular anomalies predominantly presented as pyogenic granuloma on the gingivae, while oral hemangioma was observed in adults, and lymphangioma was infrequent.
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Affiliation(s)
- M C Nwoga
- Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, College of Medicine, University of Nigeria, Enugu, Nigeria
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9
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Cohen-Cutler S, Blatt J, Bayliff S, Iacobas I, Hammill A, Sisk BA. Vascular Anomalies Care in the United States: A Cross-Sectional National Survey. J Pediatr 2023; 261:113579. [PMID: 37353145 DOI: 10.1016/j.jpeds.2023.113579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To characterize the current distribution, composition, and practice patterns of multidisciplinary vascular anomalies (VAs) teams in the US. STUDY DESIGN This is a cross-sectional survey of children's hospitals in the US offering VAs care. We approached 142 children's hospitals that provided care for VAs via email. The survey evaluated VA clinic location, medical staffing, research participation, and treatments offered. The survey was administered between October 2021 and July 2022. RESULTS Participants from 95 eligible hospitals responded to the survey (response rate = 67%). Large areas of the Midwest and Northwest US had no available multidisciplinary VA teams or clinics. Most respondents worked at academic centers (89%), with 66% at a freestanding children's hospital, and 56% reported having a multidisciplinary clinic. Most common physician participants in clinic included hematology-oncology (91%), interventional radiology (87%), dermatology (85%), plastic surgery (81%), and otolaryngology (74%). Only 38% of programs included medical geneticists. Smaller hospitals had fewer medical and ancillary staff and offered fewer therapeutic options. Research was available at most larger institutions (69%) but less commonly at smaller hospitals (34%). CONCLUSIONS Major portions of the US lack multidisciplinary VA care. Furthermore, VA programs vary in composition and geneticists are absent from the majority of programs. These findings should inform efforts to address disparate access and develop standards of care for multidisciplinary VA care in the US.
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Affiliation(s)
- Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Julie Blatt
- Division of Pediatric Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sherry Bayliff
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Kentucky Chandler Medical Center, Lexington, KY
| | - Ionela Iacobas
- Department of Pediatrics, Texas Children's Vascular Anomalies Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Adrienne Hammill
- Division of Hematology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, Cancer and Blood Diseases Institute, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Bioethics Research Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Arleo TL, Swerdlin RF, Gill AE, Goudy SL, Meisel JA, Briones MA, Shah JH, Wright A, Hawkins CM. Baseline Quality of Life in Pediatric Patients With Low-flow Vascular Malformations. J Pediatr Hematol Oncol 2023; 45:e847-e856. [PMID: 37539995 DOI: 10.1097/mph.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to quantify and describe baseline patient and parent-proxy health-related quality of life scores in patients with low-flow vascular malformations at a single, tertiary-care vascular anomalies clinic. STUDY DESIGN This is a retrospective study of data collected on patients with low-flow vascular malformations between the ages of 2 to 25 who were seen at a single, tertiary-care center vascular anomalies clinic. A total of 266 patients are included in this study. RESULTS Patients with lymphatic malformations report decreased quality of life scores as compared with venous malformations in the emotional, psychological, school, and social domains. Patients with lower extremity malformation report decreased quality of life scores as compared with head/neck, trunk, upper extremity, and multifocal malformations; most notably in the physical domain. CONCLUSIONS Treatment of low-flow vascular malformations should aim to improve patient quality of life. The use of standardized health-related quality of life measures in this study quantifies baseline quality of life scores among patients with low-flow vascular malformations.
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Affiliation(s)
| | | | - Anne E Gill
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Steven L Goudy
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University
| | - Jonathan A Meisel
- Pediatric Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine
| | - Michael A Briones
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Division of Pediatric Hematology-Oncology, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA
| | - Jay H Shah
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Allyson Wright
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
| | - Clifford Matthew Hawkins
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
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Bista B, Yousra A, Bosemani T, Gedeon D, Bista A, Shrestha S, Krishnam M. The utility of time resolved magnetic resonance angiography in differentiating vascular malformations. Clin Imaging 2023; 101:150-155. [PMID: 37364365 DOI: 10.1016/j.clinimag.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The objective is to show that TR-MRA is a useful non-invasive technique without ionizing radiation of traditional angiography in evaluating VMs. MATERIALS AND METHODS Retrospective search utilizing M-Power for MRA studies done at 3 T (Trio, Siemens) with both 3D contrast enhanced TR-MRA and 3D CE-MRA sequences from 2009 to 2018 were obtained after IRB approval. The images were blindly reviewed by two experienced cardiovascular radiologists for informations regarding vascular malformations with the ability to separate arteries and veins without any overlay or contamination in real time. Both TR-MRA and 3D CE-MRA images were carefully evaluated. The following characteristics: flow rate, size, type, feeding vessels, draining vessels and clots were evaluated. The findings were then compared to the Catheter Angiography for the patients that had catheter angiography study. RESULTS The M-Power search resulted a total of 69 patients (24 males, 45 females, age range 11 days to 74 years). Of those 69, there were 25 patients with confirmatory Catheter Angiography study. The radiologists characterized VMs as 19 high flow VMs, 47 slow flow VMs, 2 lymphatic malformations and 1 no flow VM. Of those with Cath, there was 100% concordance with the TR-MRA. CONCLUSION TR-MRA provides functional characterization of a VM that cannot be determined with CE-MRA alone. This is critical in treatment planning with high-flow VMs.
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Affiliation(s)
- Biraj Bista
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America.
| | - Abueleneen Yousra
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America
| | - Thangavijayan Bosemani
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America
| | - David Gedeon
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America
| | - Arya Bista
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America
| | - Sara Shrestha
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America
| | - Mayil Krishnam
- University of California, Orange, 101 The City Drive South, Orange, CA 92868, United States of America.
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Feng Q, Zheng X. Giant intracranial aneurysm with thrombus and calcification. Am J Med Sci 2023; 365:e75-e76. [PMID: 36563783 DOI: 10.1016/j.amjms.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/20/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Qianqian Feng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, LuZhou, SiChuan, China.
| | - Xue Zheng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, LuZhou, SiChuan, China
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Nazemian S, Sharif S, Childers ELB. Infantile Hemangioma: A Common Lesion in a Vulnerable Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085585. [PMID: 37107867 PMCID: PMC10139075 DOI: 10.3390/ijerph20085585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
Infantile hemangioma (IH) is important to all dentists, particularly dentists providing services to pediatric populations, because significant morbidity and mortality can occur from vascular lesions in children. Specialists of the oral cavity have the responsibility to identify patients with IH, a lesion that could be potentially life threatening. We present a case of IH and will provide a narrative review of the most recent literature. We discuss the diagnosis, risk stratification, treatment, complications, and impact on routine dental procedures. A proper diagnosis is crucial as oral and perioral IH are considered high-risk due to the increased risk of ulceration and feeding impairment. Referral to a hemangioma specialist for comprehensive team treatment is optimal. The natural history of IH consists of a long proliferative phase, which manifests as clinically visible growth. As a result of early encounters with patients, the pediatric dentist may often be considered the primary care provider.
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Affiliation(s)
- Samon Nazemian
- Pediatric Dentistry Resident Department of Pediatric Dentistry, College of Dentistry Howard University, Washington, DC 20059, USA
| | - Shohreh Sharif
- Greater Washington Dentistry, 3700 Joseph Siewick Drive, Fairfax, VA 22033, USA
| | - Esther L. B. Childers
- Department Oral and Maxillofacial Pathology, College of Dentistry Howard University, Washington, DC 20059, USA
- Correspondence:
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Zhang J, Croft J, Le A. Familial CCM Genes Might Not Be Main Drivers for Pathogenesis of Sporadic CCMs-Genetic Similarity between Cancers and Vascular Malformations. J Pers Med 2023; 13:jpm13040673. [PMID: 37109059 PMCID: PMC10143507 DOI: 10.3390/jpm13040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Cerebral cavernous malformations (CCMs) are abnormally dilated intracranial capillaries that form cerebrovascular lesions with a high risk of hemorrhagic stroke. Recently, several somatic "activating" gain-of-function (GOF) point mutations in PIK3CA (phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit p110α) were discovered as a dominant mutation in the lesions of sporadic forms of cerebral cavernous malformation (sCCM), raising the possibility that CCMs, like other types of vascular malformations, fall in the PIK3CA-related overgrowth spectrum (PROS). However, this possibility has been challenged with different interpretations. In this review, we will continue our efforts to expound the phenomenon of the coexistence of gain-of-function (GOF) point mutations in the PIK3CA gene and loss-of-function (LOF) mutations in CCM genes in the CCM lesions of sCCM and try to delineate the relationship between mutagenic events with CCM lesions in a temporospatial manner. Since GOF PIK3CA point mutations have been well studied in reproductive cancers, especially breast cancer as a driver oncogene, we will perform a comparative meta-analysis for GOF PIK3CA point mutations in an attempt to demonstrate the genetic similarities shared by both cancers and vascular anomalies.
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Affiliation(s)
- Jun Zhang
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
| | - Jacob Croft
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
| | - Alexander Le
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
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Beqo BP, Gasparella P, Flucher C, Tschauner S, Brcic I, Haxhija EQ. Subcutaneous Granuloma Annulare vs. Subcutaneous Vascular Malformations in Children: A Diagnostic Challenge. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020362. [PMID: 36832491 PMCID: PMC9955411 DOI: 10.3390/children10020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES There are various subcutaneous lesions in children and often there is difficulty in obtaining an accurate diagnosis by non-invasive diagnostic procedures. Subcutaneous granuloma annulare (SGA) is a rare granulomatous disease that, even after imaging, is often mistaken for a low-flow subcutaneous vascular malformation (SVM). This study aimed to accurately identify clinical and imaging clues to distinguish SGA from low-flow SVM. METHODS We retrospectively analyzed complete hospital records of all children with a confirmed diagnosis of SGA and low-flow SVM who underwent MR imaging at our institution from January 2001 to December 2020. Their disease history, clinical and imaging findings, management, and outcome were evaluated. RESULTS Among 57 patients with granuloma annulare, we identified 12 patients (nine girls) with a confirmed SGA diagnosis who underwent a preoperative MRI. Their median age was 3.25 years (range 2-5 years). Of 455 patients diagnosed with vascular malformations, 90 had malformations limited to the subcutaneous area. Among them only 47 patients with low-flow SVM were included in the study and further analyzed. Our SGA cohort had a female predilection (75%) and a short history of lump appearance of 1.5 months. SGA lesions were immobile and firm. Before MRI, patients underwent initial evaluation by ultrasound (100%) and X-ray (50%). Surgical tissue sampling was performed in all SGA patients to establish a diagnosis. All 47 patients with low-flow SVM were diagnosed correctly by MRI. A total of 45 patients (96%) underwent surgical resection of the SVM. A careful retrospective review of imaging findings of patients with SGA and SVM showed that SGA present as homogenous lesions in the shape of an epifascial cap with a typical broad fascial base extending towards the subdermal tissue in the middle of the lesion. In contrast, SVMs always present with variable-sized multicystic or tubular areas. CONCLUSIONS Our study shows clear clinical and imaging differences between low-flow SVMs and SGA. SGA presents characteristically in the shape of a homogenous "epifascial cap," which distinguishes these lesions from multicystic heterogenous SVMs.
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Affiliation(s)
- Besiana P. Beqo
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Christina Flucher
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, A-8036 Graz, Austria
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
| | - Emir Q. Haxhija
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
- Correspondence: ; Tel.: +43-(0)316-38513762; Fax: +43-(0)316-38513775
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16
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Kerr AM, Bereitschaft C, Duty KM, Sisk BA. Navigating care for rare diseases: Caregiver and patient advice for families and clinicians managing care for vascular malformations. PATIENT EDUCATION AND COUNSELING 2023; 107:107569. [PMID: 36410314 DOI: 10.1016/j.pec.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Families affected by rare diseases face many challenges finding adequate care and often report poor communication with clinicians. In the current study, we explore patient and caregiver advice for families and clinicians in the context of complex vascular malformations (VMs), a condition that is frequently misunderstood and misdiagnosed. METHODS We performed semi-structured interviews with 21 adult patients with complex VMs and 24 caregivers of children with VMs. We analyzed the transcripts using thematic analysis. RESULTS Participants advised patients and caregivers to advocate for care, address mental and emotional well-being, seek social support, and promote self-management and self-care. Participants advised clinicians to show care and concern, show commitment, empower and validate, communicate information clearly, address mental/emotional well-being, acknowledge the broad impact of disease and treatment, acknowledge your limitations, work as a team, and commit to learning. CONCLUSION Participants' advice revealed challenges related to family-centered communication and patient and caregiver quality of life and demonstrated the importance of self-advocacy and social support. PRACTICE IMPLICATIONS The result of this study can help newly-diagnosed families overcome challenges related to care and communication. Clinicians can also use the results to support families by offering them our accompanying handout to validate families' experiences and relay this advice.
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Affiliation(s)
- Anna M Kerr
- Department of Primary Care, Ohio University, Dublin, OH 43016, USA.
| | | | - Kayla M Duty
- School of Communication, Ohio University, Athens, OH 45701, USA
| | - Bryan A Sisk
- Department of Pediatrics, Washington University, St. Louis, MO 63130, USA
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Müller J, Henrich M, Hoogen-Merkel J, Hartung S. Granulation tissue-type hemangioma in a 6-week-old puppy - a case report. BMC Vet Res 2022; 18:431. [PMID: 36503485 PMCID: PMC9743495 DOI: 10.1186/s12917-022-03503-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hemangioma is a well-known neoplasia in veterinary and human medicine. Several subtypes have been described and are distinguished based on their histologic appearance. The classification schemes of hemangiomas in human and veterinary medicine are different, and various purpose-based schemes can be found in the literature. CASE PRESENTATION A six-week-old puppy was presented that suffered from a neoplasia that extended to the musculature of the hind limb. After surgical excision, the mass was submitted for pathohistological examination. The mass was composed of endothelial cells forming vascular slits admixed with a fibrous stroma and spindle cells. Immunohistological examination was positive for factor VIII-related antigen and smooth muscle actin, supporting the diagnosis of hemangioma. CONCLUSION The final diagnosis of granulation tissue-type hemangioma was given due to the histological appearance of the neoplasia. Granulation tissue-type hemangioma is a rare subtype of hemangioma. In this case an uncommonly young dog was affected.
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Affiliation(s)
- Janina Müller
- grid.8664.c0000 0001 2165 8627Institute of Veterinary Pathology, Justus-Liebig-University Giessen, Frankfurter Straße 96, 35392 Giessen, Germany
| | - Manfred Henrich
- grid.8664.c0000 0001 2165 8627Institute of Veterinary Pathology, Justus-Liebig-University Giessen, Frankfurter Straße 96, 35392 Giessen, Germany
| | | | - Svenja Hartung
- grid.8664.c0000 0001 2165 8627Institute of Veterinary Pathology, Justus-Liebig-University Giessen, Frankfurter Straße 96, 35392 Giessen, Germany
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18
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Sharma S, Rayamajhi A, Shrestha JM. A lymphatic malformation with a “Lympholith” and encasing neurovascular structures in the arm of a 2‐year‐old child: A case report. Clin Case Rep 2022; 10:e6608. [DOI: 10.1002/ccr3.6608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Samit Sharma
- Department of Plastic Surgery and Burns Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Aadesh Rayamajhi
- Institute of Medicine, Maharajgunj Medical Campus Tribhuvan University Kathmandu Nepal
| | - Jayan Man Shrestha
- Department of Plastic Surgery and Burns Tribhuvan University Teaching Hospital Kathmandu Nepal
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19
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Factors affecting pathways to care for children and adolescents with complex vascular malformations: parental perspectives. Orphanet J Rare Dis 2022; 17:271. [PMID: 35840977 PMCID: PMC9287854 DOI: 10.1186/s13023-022-02432-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Complex vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Patients with complex VMs experience misdiagnosis, delayed diagnosis, delayed or inappropriate treatments, and worsened health. Given the potential consequences of delaying expert care, we must identify the factors that impede or facilitate this access to care.
Results We performed semi-structured interviews with 24 parents (21 mothers; 3 fathers; median age = 42.5 years) of children with complex VMs and overgrowth disorders living in the US, recruited through two patient advocacy groups – CLOVES Syndrome Community, and Klippel-Trenaunay Support Group. We performed thematic analysis to assess parental perspectives on barriers and facilitators to accessing expert care. We identified 11 factors, representing 6 overarching themes, affecting families’ ability to access and maintain effective care for their child: individual characteristics (clinician behaviors and characteristics, parent behaviors and characteristics), health care system (availability of specialist multidisciplinary teams, care coordination and logistics, insurance and financial issues, treatments and services), clinical characteristics (accuracy and timing of diagnosis, features of clinical presentation), social support networks, scientific progress, and luck and privilege. Additionally, access to information about VMs and VM care was a crosscutting theme affecting each of these factors. These factors influenced both the initial access to care and the ongoing maintenance of care for children with VMs. Conclusion Parents of children with VMs report multiple factors that facilitate or impede their ability to provide their child with optimal care. These factors represent possible targets for future interventions to improve care delivery for families affected by VMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02432-4.
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20
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Riley GM, Kwong S, Steffner R, Boutin RD. MR Imaging of Benign Soft Tissue Tumors. Radiol Clin North Am 2022; 60:263-281. [DOI: 10.1016/j.rcl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Painful swelling of the arm due to a bizarre intramuscular vascular malformation. J Orthop Sci 2022; 27:504-507. [PMID: 31431314 DOI: 10.1016/j.jos.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022]
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22
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Nagammai N, Gopal KS, Srinivasan S. Venolymphatic malformation. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Tovichien P, Kaeotawee P, Udomittipong K, Pacharn P, Ruangchira‐urai R. A rare case of mediastinal lymphatic venous malformations in children. Respirol Case Rep 2021; 9:e0881. [PMID: 34849235 PMCID: PMC8611408 DOI: 10.1002/rcr2.881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
We report a case of mediastinal lymphatic venous malformations (LVM) in a 11-year-old boy who presented with chest pain after jumping into a swimming pool, with review of the literature. A superior mediastinal mass was incidentally found from the chest x-ray. Chest computed tomography revealed a large heterogenous mass at the left-sided mediastinum containing fat, minimal enhancing solid portion, non-enhancing cystic portion and calcification. Because of the large size of the mass, the patient underwent tumour removal. Operative findings gave a definitive diagnosis of mediastinal LVM. The patient had an uneventful clinical course and was discharged without complication. This report highlights that it is possible to misdiagnose mediastinal LVM especially if its predominant portion is lymphatic tissue with only minimal contrast enhancement. Tissue biopsy must be avoided because it may lead to haemorrhagic complication.
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Affiliation(s)
- Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
| | - Phatthareeda Kaeotawee
- Division of Pulmonology, Department of Pediatrics, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
| | - Preeyacha Pacharn
- Radiology Department, Faculty of MedicineSiriraj Hospital Mahidol UniversityBangkokThailand
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24
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Samet JD, Restrepo R, Rajeswaran S, Lee EY, Green JR. Pediatric Vascular Malformations: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:179-192. [PMID: 34836564 DOI: 10.1016/j.rcl.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vascular malformations are commonly encountered in the pediatric population. This article reviews the imaging appearances of simple and syndromic vascular malformations in infants and children that radiologists should know and provides imaging guidelines based on an evidence-based approach. Malformations are discussed within the framework of the International Society for the Study of Vascular Anomalies classification system.
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Affiliation(s)
- Jonathan D Samet
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue Box 9, Chicago, IL 60611, USA.
| | - Ricardo Restrepo
- Department of Interventional Radiology and Body Imaging, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Shankar Rajeswaran
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue Box 9, Chicago, IL 60611, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jared R Green
- Joe DiMaggio Children's Hospital, Envision Radiology associates of Hollywood, 500 N Hiatus Road, Suite 200, Pembroke Pines, FL 33026, USA
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25
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Verma M, Ojha V, Kumar S, Ramakrishnan S. Tetralogy of Fallot with haemangioma of the upper extremity in a child with biventricular failure: a diagnostic conundrum. BMJ Case Rep 2021; 14:e247195. [PMID: 34764132 PMCID: PMC8587452 DOI: 10.1136/bcr-2021-247195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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26
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Sarfi D, Adnane S, Haitami S, Ben Yahya I. Diode laser photocoagulation of intraoral (and perioral) venous malformations: Cases series. Int J Surg Case Rep 2021; 88:106436. [PMID: 34710772 PMCID: PMC8577465 DOI: 10.1016/j.ijscr.2021.106436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022] Open
Abstract
Vascular anomalies are subdivided into vascular tumors (hemangiomas) and vascular malformations. They are frequently located in the head, neck, and oral cavity. They are common complaints reported in patients seeking treatment for aesthetic or functional issues. However, recent advances in the diagnosis and management of these lesions are improving treatment strategies. This review provides both basic and up-to-date knowledge on the most common vascular anomalies encountered by practitioners. Due to the wide variability of treatment options which often generates debate, this paper work aims to provide a comprehensive approach of these lesions based upon current concepts and practical clinical experience. Our article is about 4 patients who had consulted for one or several purplish, elevated, well limited and soft lesion. These lesions was not painful, but worrying for patients. Therapies for VAs continue to generate a dilemma for oral surgeons. Several treatment options were reported, including conventional surgery with or without adjunctive preoperative embolization, and drug therapies, such corticosteroids, intralesional injection of corticosteroids and intralesional injections of sclerosing agents. All of these therapeutic approaches carry a high risk of severe side effects such as scars, pain, and bleeding [7]. Nowadays, advances in the use of lasers have allowed doctors an effective treatment with minimal side effects [9]. All our cases described in this article were done by Pr Haitami, using the 980 nm Diode laser, and a complete healing was observed in about 8 months at the most. The laser is therefore a great help in the management of this type of lesion.
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Affiliation(s)
- Dounia Sarfi
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco, BP: 9157.
| | - Salma Adnane
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco, BP: 9157
| | - Sofia Haitami
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco, BP: 9157
| | - Ihsane Ben Yahya
- Oral Surgery, Dental Consultation and Treatment Center, Ibn Rochd University Hospital Center, Casablanca, Morocco, BP: 9157
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27
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Kerr AM, Sisk BA. Unanswered questions and unmet needs: A call for communication research in vascular anomalies. PATIENT EDUCATION AND COUNSELING 2021; 104:2839-2842. [PMID: 33858723 DOI: 10.1016/j.pec.2021.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Anna M Kerr
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| | - Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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28
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Lai KKH, Li CK, Tsang A, Wong SYS, Ko CKL. Ocular adnexal intramuscular hemangioma arising from the eyelid: case report and literature review. Orbit 2021; 42:290-294. [PMID: 34686104 DOI: 10.1080/01676830.2021.1990352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intramuscular hemangioma (IMH) is rare in the ocular adnexa and is uncommonly found in infants. We describe a 1-month-old female infant with an unremarkable birth history presented with subacute onset of right upper eyelid swelling. Clinical examination revealed a purplish subcutaneous mass over the right upper eyelid causing mechanical ptosis. MRI revealed a well-defined subcutaneous mass, which was hyperintense on the T1 weighted images and showed intense enhancement after administration of intravenous gadolinium. Our working diagnosis was infantile capillary hemangioma, and the patient received two intralesional steroid injections without diminishing the lesion size. The lesion had become static in size and the subsequent MRI 14 years later revealed the same lesion had become hyperintense on the T1 weighted image. An excisional biopsy revealed mixed type IMH. IMH should be considered among young patients with upper eyelid swelling, particularly in those who show a poor response to steroid treatment.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
| | - Chun Kit Li
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alan Tsang
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
| | - Sivia Y S Wong
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China
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29
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Sahoo NK, Bhat S, Kumar S. Neonatal vascular malformation of parietal bone. Natl J Maxillofac Surg 2021; 12:431-434. [PMID: 35153445 PMCID: PMC8820297 DOI: 10.4103/njms.njms_253_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 07/31/2021] [Indexed: 11/28/2022] Open
Abstract
Vascular malformations (VaMs) are congenital lesions and are present at birth. They grow commensurately with age. These lesions often affect the soft tissues with intraosseous involvement of the scalp being rare. Here, we discuss a case of intraosseous VaM in a 2-month-old infant which was involving the parietal bone.
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Affiliation(s)
- N K Sahoo
- Department of Oral and Maxillofacial Surgery, Army Dental Centre (R and R), New Delhi, India
| | | | - Sanjay Kumar
- Department of Neurosurgery, Armed Forces Medical College, Pune, Maharashtra, India
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30
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Anajar S, Nawal B, Amal H, Fouad B. Internal jugular vein cavernous hemangioma occurring as lateral neck mass: Case report. Int J Surg Case Rep 2021; 85:106205. [PMID: 34352622 PMCID: PMC8350403 DOI: 10.1016/j.ijscr.2021.106205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cavernous hemangioma is a venous malformation that occurs throughout the entire body but is rarely localized in internal jugular vein, to the best of our knowledge our case is the first case reported in the literature. CASE REPORT We report a case of internal jugular vein cavernous hemangioma in a 62-year-old woman and review the literature concerning the clinical features, radiological appearance, histopathological findings and treatment options. DISCUSSION Internal jugular vein cavernous hemangioma, is a very rare tumor composed of large dilated blood vessels and containing large blood-filled spaces. It can occur as lateral neck mass, in our case neither the scanner nor the ultrasound made the diagnosis. Given the rarity of the condition, therapeutic strategies remain unclear. However, according to the published literature, complete resection is considered the most successful and effective treatment.
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Affiliation(s)
- Said Anajar
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Bouknani Nawal
- Radiology Department, Hospital Chekh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Hajjij Amal
- ENT Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Benariba Fouad
- ENT Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
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31
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Feygin T, Goldman-Yassen AE, Licht DJ, Schmitt JE, Mian A, Vossough A, Castelo-Soccio L, Treat JR, Bhatia A, Pollock AN. Neuroaxial Infantile Hemangiomas: Imaging Manifestations and Association with Hemangioma Syndromes. AJNR Am J Neuroradiol 2021; 42:1520-1527. [PMID: 34244133 DOI: 10.3174/ajnr.a7204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Infantile hemangiomas are common lesions in the pediatric population; in rare cases, an infantile hemangioma can be detected along the neural axis. The purposes of our study included determination of the incidence, location, and imaging appearance of neuroaxial infantile hemangiomas and their syndromic association. We also assessed additional features of cerebral and cardiovascular anomalies that may be associated with neuroaxial lesions. MATERIALS AND METHODS A retrospective cohort study was performed, searching the radiology database for patients with segmental infantile hemangiomas referred for assessment of possible hemangioma syndromes. We retrospectively reviewed brain and spine MR imaging studies, with particular attention paid to neuroaxial vascular lesions, as well as the relevant clinical data. Neuroaxial hemangioma imaging findings were described, and comparison of segmental cutaneous infantile hemangioma location with the imaging findings was performed in patients with confirmed hemangioma syndromes and in patients with isolated skin infantile hemangioma. RESULTS Ninety-five patients with segmental infantile hemangioma were included in the study, 42 of whom had a hemangioma syndrome; of those, 41 had posterior fossa brain malformations, hemangioma, arterial lesions, cardiac abnormalities, and eye abnormalities (PHACE) syndrome and 1 had diffuse neonatal hemangiomatosis. Neuroaxial involvement was detected in 20/42 patients (48%) with hemangioma syndromes and in no subjects with isolated segmental infantile hemangioma (P < .001). The most common intracranial hemangioma location was within the ipsilateral internal auditory canal (83%). CONCLUSIONS Many pediatric patients with segmental infantile hemangioma in the setting of hemangioma syndromes, especially those with PHACE, had neuroaxial hemangiomas. This finding may potentially lead to requiring additional clinical evaluation and management of these patients.
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Affiliation(s)
- T Feygin
- Division of Neuroradiology (T.F., A.V., A.N.P.), Department of Radiology, The C hildren's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A E Goldman-Yassen
- Department of Radiology (A.E.G.-Y.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - D J Licht
- Department of Neurology (D.J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J E Schmitt
- Division of Neuroradiology (J.E.S.), Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Mian
- Division of Neuroradiology (A.M.), Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - A Vossough
- Division of Neuroradiology (T.F., A.V., A.N.P.), Department of Radiology, The C hildren's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L Castelo-Soccio
- Department of Dermatology (L.C.-S, J.R.T.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J R Treat
- Department of Dermatology (L.C.-S, J.R.T.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Bhatia
- Department of Radiology (A.B.), The Children's Hospital of Pittsburg, Philadelphia, Pennsylvania
| | - A N Pollock
- Division of Neuroradiology (T.F., A.V., A.N.P.), Department of Radiology, The C hildren's Hospital of Philadelphia, Philadelphia, Pennsylvania
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32
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Gupta D, Gupta S, Mittal A, Garg P. Diagnosis and Management of Cavernous Hemangioma of the Tongue with Sclerosing Agents: A Case Report and Review of Literature. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Mejia O, Bahmad HF, Oh KS, Paramo JC, Poppiti R. Parathyroid hemangioma. AUTOPSY AND CASE REPORTS 2021; 11:e2021270. [PMID: 34249786 PMCID: PMC8253379 DOI: 10.4322/acr.2021.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hemangiomas are benign neoplasms of capillary proliferation that arise from a developmental anomaly where angioblastic mesenchyme fails to form canals. Most hemangiomas arise in the head and neck region, either superficially in the skin or deeper within endocrine organs such as the parotid gland. Parathyroid hemangiomas, however, are extremely rare, with only five cases previously reported in the literature. Case presentation Herein, we present a case of a 68-year-old man with a hemangioma almost completely replacing the right upper parathyroid gland, grossly measuring 1.3 × 1.3 × 1.2 cm and weighing 700 mg, associated with primary hyperparathyroidism. Conclusions Parathyroid gland enlargement due to vascular neoplasms such as hemangiomas can mimic, both clinically and radiographically, hyperplasias and/or adenomas. Surgeons need to be aware of the presence of this entity and should consider it in the differential diagnosis of hyperparathyroidism or parathyroid gland enlargement.
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Affiliation(s)
- Odille Mejia
- Mount Sinai Medical Center, Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Hisham F Bahmad
- Mount Sinai Medical Center, Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Kei Shing Oh
- Mount Sinai Medical Center, Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Juan C Paramo
- Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Robert Poppiti
- Mount Sinai Medical Center, Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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34
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Malik V, Kramadhari H, Rathod J, Munde YW, Kovilapu UB. Peripheral Arteriovenous Malformations: Imaging and Endovascular Management Strategies. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThe peripheral high-flow vascular malformation (HFVM) comprises arteriovenous malformation (AVM) and fistula (AVF), shows varied clinical presentation (ranging from subtle skin lesion to life-threatening congestive heart failure), and frequently poses diagnostic and therapeutic challenges. Importance of assigning a specific diagnosis to the vascular malformation cannot be overstated, as the treatment strategy is based on the type of vascular anomaly. Although the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most commonly accepted system for classifying congenital vascular anomalies in clinical practice, the Cho–Do et al classification is of utmost help in guiding optimal mode of treatment in peripheral AVM. Although transarterial approach remains the most commonly employed route for peripheral AVM embolization, the role of transvenous and direct percutaneous approach is ever increasing and the final decision on the approach depends on angioarchitecture of the AVM. In this article, we review various commonly employed classification systems for congenital vascular anomalies, and describe clinical features, imaging and treatment strategies for peripheral arteriovenous malformation (PAVM).
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Affiliation(s)
- Virender Malik
- Army Institute of Cardiothoracic sciences (AICTS), affiliated to Armed Forces Medical College, Pune, India
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35
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Mittal A, Anand R, Gauba R, Choudhury SR, Abbey P. A Step-by-Step Sonographic Approach to Vascular Anomalies in the Pediatric Population: A Pictorial Essay. Indian J Radiol Imaging 2021; 31:157-171. [PMID: 34316124 PMCID: PMC8299503 DOI: 10.1055/s-0041-1729486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vascular anomalies are a common cause of soft-tissue masses in children and often referred for ultrasonographic (USG) evaluation. They are broadly classified as vascular tumors (hemangiomas, hemangioendotheliomas, and angiosarcomas) or vascular malformations (venous malformations, lymphatic malformations, and arteriovenous malformations). Findings on USG and Doppler imaging can be used to categorize vascular anomalies into high- or low-flow lesions, which forms the basis for further workup, diagnosis, and management. On careful evaluation of various sonographic features, in conjunction with clinical findings, an accurate clinicoradiological diagnosis can be made in most cases. Further imaging with magnetic resonance (MR) imaging or computed tomography (CT) helps in delineation of lesion extent, whereas MR or CT angiography is useful to map the vascular supply of high-flow lesions. We have illustrated and discussed a step-by-step approach to diagnose vascular anomalies using ultrasound and Doppler imaging.
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Affiliation(s)
- Anushka Mittal
- Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rama Anand
- Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Richa Gauba
- Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Pooja Abbey
- Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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36
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Abu Ata N, Meyers AB, Merrow AC. Imaging of Vascular Anomalies in the Pediatric Musculoskeletal System. Semin Roentgenol 2021; 56:288-306. [PMID: 34281681 DOI: 10.1053/j.ro.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arnold C Merrow
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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37
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Pang C, Evans N, Jethwa P, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Lim CS, Brookes J. Single Center Experience of Sirolimus Therapy in Head and Neck Low-flow Vascular Malformations. Vasc Endovascular Surg 2021; 55:482-490. [PMID: 33878964 DOI: 10.1177/15385744211010378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recently, studies have shown that sirolimus is clinically efficacious in the treatment of some low-flow vascular malformations (LFVM). This study aimed to assess the efficacy and safety of sirolimus in treating complex head and neck (H&N) LFVM that were challenging and/or refractory to standard treatment. METHODS Each patient had baseline and 6-months assessments consisting of clinical history and examination, quality of life (QoL) questionnaires, laboratory investigations, MRI and medical photography. Patients were followed up 1-week and then 1-monthly for 6-months. Wilcoxon signed-rank test was used to compare pre-and 6-months treatment in all 8 domains of RAND 36-Item Short Form Health Survey (SF-36), hospital anxiety and depression scale (HADS), and visual analog score for pain (VAS-P). P < 0.05 was considered significant. RESULTS Seven patients (median age 43 years, range 23-65 years) were recruited. Six patients completed the six-months course of therapy with 1 patient withdrawing due to intolerable side effects. All six patients reported reduction of swelling with and without other symptom improvement related to the vascular malformations while on treatment. However, at 1-month review after discontinuation of sirolimus, 5 patients reported return of initial symptoms. Overall, patients demonstrated an improvement in QoL six-months treatment but there was no statistical significance (P > 0.05) in all 8 domains of SF-36, HADS and VAS-P. Five patients demonstrated a minimum 10% decrease in lesion size six-months treatment (median 21%, range 13-40%). A Wilcoxon signed-rank test showed that sirolimus treatment did elicit a statistically significant change in lesion size in either direction (Z = -1.992, P = 0.046). The most common side effects found were dyslipidaemia (n-4) and mouth ulcers (n = 2). CONCLUSION In our preliminary experience, sirolimus is effective and safe in treating patients with complex H&N LFVM. This provides an alternative treatment where standard treatment is challenging and/or refractory.
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Affiliation(s)
- Calver Pang
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom
| | - Nicholas Evans
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Poonam Jethwa
- Department of Pharmacy, 4965Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anthie Papadopoulou
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mohamed Khalifa
- Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom
| | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom
| | - Chung Sim Lim
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom.,Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom
| | - Jocelyn Brookes
- Department of Vascular Surgery, 4965Royal Free London NHS Foundation Trust, London, United Kingdom.,Department of Interventional Radiology, 4965Royal Free London NHS Foundation Trust, London, United Kingdom
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38
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Quddus A, Karia P, Khurram R, Parthipun A, Brookes J. Illuminating the nidus: The role of FDG PET/CT in high flow arteriovenous vascular malformations. Radiol Case Rep 2021; 16:1374-1377. [PMID: 33897932 PMCID: PMC8055530 DOI: 10.1016/j.radcr.2021.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/20/2021] [Indexed: 01/03/2023] Open
Abstract
The appropriate identification and localization of a nidus of a high flow arteriovenous malformation is crucial to guide targeted interventional therapy. However, the nidus of a complex or previously treated HFAVM can be difficult to non-invasively demonstrate on magnetic resonance imaging alone. We describe a unique case of a 56-year-old female with a complex high flow arteriovenous malformation in which we demonstrated the feasibility of fluorodeoxyglucose positron emission tomography/computed tomography to non-invasively delineate the nidus which subsequently guided successful targeted interventional therapy.
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Affiliation(s)
- Ayyaz Quddus
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, NW3 2QG, UK
| | - Priyesh Karia
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, NW3 2QG, UK
| | - Ruhaid Khurram
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, NW3 2QG, UK,Corresponding author.
| | - Arum Parthipun
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, NW3 2QG, UK
| | - Jocelyn Brookes
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, NW3 2QG, UK
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39
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Luca AC, Miron IC, Trandafir LM, Cojocaru E, Pădureţ IA, Trandafirescu MF, Iordache AC, Ţarcă E. Morphological, genetic and clinical correlations in infantile hemangiomas and their mimics. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:687-695. [PMID: 33817710 PMCID: PMC8112746 DOI: 10.47162/rjme.61.3.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infantile hemangiomas (IHs) are the most frequent pediatric benign vascular tumors, with a reported incidence of 5% to 10%. They have self-limiting evolution pattern divided into a growth phase in the first 12 months and a regression one, that may take up to 10 years. Occasionally, hemangiomas might lead to local or systemic complications, depending on their morphological characteristics. The first line of treatment is β-blockers, such as Propranolol, Timolol, Nadolol, administered either locally or systemically. Newer therapeutic strategies involving laser therapy and angiotensin-converting enzyme inhibitors are being studied, while older treatment modalities like corticosteroids, Imiquimod, Vincristine, Bleomycin and Interferon-α have become second line therapy options. Before establishing the appropriate treatment, clinical, histological, and imaging investigations are required.
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Affiliation(s)
- Alina Costina Luca
- Department of Morphofunctional Sciences I - Pathology, Department of Mother and Child Medicine - Pediatrics, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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40
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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41
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Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging 2021; 17:197-216. [PMID: 32660406 DOI: 10.2174/1573405616666200713183400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/08/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Differentiation of malignant from benign soft tissue tumors is challenging with imaging alone, including that by magnetic resonance imaging and computed tomography. However, the accuracy of this differentiation has increased owing to the development of novel imaging technology. Detailed patient history and physical examination remain essential for differentiation between benign and malignant soft tissue tumors. Moreover, measurement only of tumor size based on Response Evaluation Criteria In Solid Tumors criteria is insufficient for the evaluation of response to chemotherapy or radiotherapy. Change in metabolic activity measured by 18F-fluorodeoxyglucose positron emission tomography or dynamic contrast enhanced-derived quantitative endpoints can more accurately evaluate treatment response compared to change in tumor size. Magnetic resonance imaging can accurately evaluate essential factors in surgical planning such as vascular or bone invasion and "tail sign". Thus, imaging plays a critical role in the diagnosis and treatment of soft tissue tumors.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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42
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Derindağ G, Sarıca İ, Çağlayan F. Examination of oral hemangiomas by intraoral ultrasonography. Oral Radiol 2021; 37:687-692. [PMID: 33656695 DOI: 10.1007/s11282-021-00511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Oral hemangioma is a benign vascular tumor characterized by the presence of numerous blood vessels. We aimed to examine the clinical and ultrasonographic findings of patients diagnosed with oral hemangioma in our ultrasonography (USG) archive, retrospectively. METHODS This study was conducted by examining 20 patients diagnosed with oral hemangioma and underwent USG examination in the Department of Oral and Maxillofacial Radiology of Atatürk University Faculty of Dentistry from 2016 to 2020. All patients had intraoral and radiographic examinations. Patients pre-diagnosed clinically oral hemangioma were evaluated as intraoral with USG. The intraoral USG examinations were performed using both the B-mode and the color Doppler mode. RESULTS The mean age of the patients was 42.4 ± 19.14 years; 16 patients were female and four were male. The lesions were mostly observed on the alveolar mucosa (30%), followed by the buccal mucosa (25%), the lower lip (15%), the mouth floor (15%), the tongue (15%). In intraoral USG examinations of all oral hemangiomas, we detected submucosal located, well-defined, lobulated, non-capsule, hypo-isoechoic, heterogeneous lesion areas. Additionally, while we detected only peripheral blood flow in 6 (30%) of 20 patients, we detected both internal and peripheral blood flow in 14 (70%). CONCLUSIONS In our study, the examination of the oral hemangiomas with the intraoral probe and the color Doppler mode was very helpful in the differential diagnosis. Although histopathology has an important place in definitive diagnosis, particularly intraoral USG can provide sufficient information for the diagnosis of oral hemangiomas.
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Affiliation(s)
- Gözde Derindağ
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey.
| | - İrfan Sarıca
- Health Cares Vocational School, Bezmialem Vakıf University, İstanbul, Turkey
| | - Fatma Çağlayan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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43
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Heeger AP, Ackman JB. Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions. Radiol Clin North Am 2021; 59:251-277. [PMID: 33551086 DOI: 10.1016/j.rcl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on chest radiography and computed tomography, increasing diagnostic specificity, preventing unnecessary intervention, and guiding intervention or surgery when needed. The combination of its higher soft tissue contrast and ability to image dynamically during free breathing, without ionizing radiation exposure, allows more thorough and readily appreciable assessment of a lesion's invasiveness and assessment of phrenic nerve involvement, with significant implications for prognostic clinical staging and surgical management.
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Affiliation(s)
- Allen P Heeger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanne B Ackman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA.
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44
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Karunaratne YG, Greer D, Hong LH, Somia N, Wargon O, Adams S. Low-flow vascular malformations of the hand and forearm: a multidisciplinary experience in a tertiary paediatric centre. ANZ J Surg 2021; 91:1739-1743. [PMID: 33475243 DOI: 10.1111/ans.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular malformations (VMs) involving the hand and forearm in children provide management challenges due to complex anatomy, indispensable functionality and developmental implications. METHODS The institution's Vascular Registry was searched for patients with hand and arm VMs, supplemented by chart review of included patients. RESULTS Twenty-one patients were identified, 52% male, with mean presenting age 5.2 years. Venous malformations predominated (71%), followed by lymphatic-venous (19%), lymphatic (5%) and glomuvenous (5%). Symptoms included pain (76%), swelling (71%), cosmetic concerns (81%), functional compromise (29%) and stiffness (5%). Imaging modality was ultrasound (100%), and magnetic resonance imaging (71%). Treatment included compression (62%), sclerotherapy (62%) and surgery (24%). Post-sclerotherapy ultrasounds showed complete sclerosis (25%), near complete sclerosis (58%) and partial sclerosis (17%). Post-surgery, patients reported improved cosmesis (80%), size (100%), pain (60%) and function (40%). Complications occurred in 24%, including bleeding, digital ischaemia and thrombosis. Mean follow-up was 3.4 years. CONCLUSION Children with low-flow VMs of the hand and forearm experience significant symptoms and functional limitations. A multidisciplinary approach to management ensures optimal outcomes.
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Affiliation(s)
- Yasiru G Karunaratne
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Douglas Greer
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Ling H Hong
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Naveen Somia
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Orli Wargon
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Susan Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Höhn F, Hammer S, Fellner C, Zeman F, Uller W, Brill R, Guntau M, Wildgruber M, Wohlgemuth WA. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. ROFO-FORTSCHR RONTG 2020; 193:446-458. [PMID: 33003248 DOI: 10.1055/a-1253-8422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess morphological and hemodynamic characteristics of peripheral vascular malformations on 3 T magnetic resonance imaging (MRI) including qualitative comparison of two fat-saturated sequences: short tau inversion recovery (STIR) and three-dimensional high-resolution volume interpolated gradient recalled echo (GRE). MATERIALS AND METHODS During 9 months, 100 patients with suspected or known vascular malformations were prospectively assessed on a 3 T scanner using T2-weighted STIR and turbo spin echo (TSE), T1-weighted TSE, time-resolved contrast-enhanced magnetic resonance angiography (MRA) with interleaved stochastic trajectories (TWIST) and T1-weighted volume interpolated breath-hold examination (VIBE) after contrast enhancement. The analysis included signal behavior and morphologic and hemodynamic characteristics. Additionally, the image quality of the fat-saturated sequences was evaluated by 2 radiologists. RESULTS 86 patients (14 dropouts; 57 female, 29 male; mean age 26.8 years, age range 1-56) were analyzed. 22 had high-flow and 64 low-flow malformations, including 14 with a lymphatic component. In 21 of 22 patients with high-flow malformations, typical characteristics (flow voids, hyperdynamic arteriovenous fistula, dilated main/feeder-arteries and draining veins) were documented. Patients with low-flow malformations had phleboliths in 35 cases, fluid-fluid levels in 47 and dilated draining veins in 23. Lymphatic malformations showed peripheral contrast enhancement of cyst walls in the volume interpolated GRE. The comparison of fat-saturated sequences showed significantly better results of the volume interpolated GRE in all categories except the presence of artifacts which were significantly reduced in the STIR (p < 0.05). CONCLUSION 3 T MRI with MRA provides detailed morphological and hemodynamic information of different types of peripheral vascular malformations. Contrast-enhanced high-resolution volume interpolated GRE proved superior to STIR in differentiating morphologic features and to be diagnostic in the differentiation of lymphatic parts and joint involvement. KEY POINTS · 3 T MRI with MRA offers detailed information about vascular malformations.. · Fat-saturated MRI provides especially information about morphological characteristics, extent and tissue involvement.. · Volume interpolated GRE proved superior in almost all categories compared to STIR.. · Volume interpolated GRE showed more artifacts.. · Volume interpolated GRE additionally allows differentiation of lymphatic parts and evaluation of joint involvement.. CITATION FORMAT · Höhn F, Hammer S, Fellner C et al. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. Fortschr Röntgenstr 2021; 193: 446 - 458.
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Affiliation(s)
- Florentine Höhn
- Clinic and Policlinic of Nuclear Medicine, University Hospital Würzburg, Germany
| | - Simone Hammer
- Department of Radiology, University Hospital Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Regensburg, Germany
| | - Richard Brill
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Guntau
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Clinical Radiology, University Hospital Münster, Germany
| | - Walter A Wohlgemuth
- University Clinic and Policlinic of Radiology, Martin Luther University Hospital Halle-Wittenberg, Halle (Saale), Germany
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Ganapathy S, Pandey P. Neurosurgery in paediatric strokes. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-020-00091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractPaediatric strokes are a different entity owing to the difference in pathological entity causing the stroke as well as difficulty in treatment and management due to the presence of a growing brain and small vascular volume making surgery and endovascular intervention dangerous. Yet, the high neuronal plasticity coupled with unique surgical and endovascular procedures makes surgery in these conditions rewarding with improving morbidity and mortality statistics. The field is young and dynamic leading to constant change and updating. We attempt to review the current recommendations with our own experience in paediatric neurosurgery for paediatric strokes and present an overview of common conditions causing paediatric strokes. A brief review of the literature is also supplied for reference.
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47
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Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
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48
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Sonography of abdominal wall vascular malformation: a case report and review of the literature. J Ultrasound 2020; 23:481-485. [PMID: 32886344 DOI: 10.1007/s40477-020-00523-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
Vascular anomalies are classified as vascular tumors (VT) and vascular malformations (VM). VTs are divided according to their clinical behavior, while VMs are classified according to their flow characteristics, histopathologic features, and associations with other anomalies. Sonography emerges as the diagnostic imaging method of first choice for assessing abdominal wall disorders and masses, thus representing a valuable tool for the diagnosis and follow-up of abdominal wall VMs. In this review, we report a case of abdominal wall arteriovenous malformation (AVM) in a 17-year old and briefly discuss the cases of abdominal wall VMs.
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49
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Ng C, Mentias Y, Abdelgalil A. Imaging features of non-epithelial tumours of the larynx. Clin Radiol 2020; 75:711.e5-711.e12. [DOI: 10.1016/j.crad.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/23/2020] [Indexed: 12/27/2022]
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50
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Ramachandran S, Mukherjee D, Delf J, Bown MJ, Kandiyil N. A comparison of arterial spin labelling with catheter angiography in evaluating arteriovenous malformations: a systematic review. Br J Radiol 2020; 93:20190830. [PMID: 32208976 PMCID: PMC10993222 DOI: 10.1259/bjr.20190830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the performance of arterial spin labelling (ASL) in evaluating arteriovenous malformations (AVMs) against the current gold standard of catheter angiography. METHODS We systematically reviewed the published literature using EMBASE and Medline. We included studies that compared ASL to catheter angiography in the assessment of AVMs in three outcome domains: detection, angioarchitectural and haemodynamic features. RESULTS From 314 unique citations, 19 studies representing 289 patients with intracranial AVMs met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. Seven studies showed high diagnostic performance of ASL in identifying arterial feeders, with sensitivity ranging from 84.6 to 100% and specificity ranging from 93.3 to 100%. Six studies showed strong ability in detecting arteriovenous shunting, with sensitivity ranging from 91.7 to 100% and specificity ranging from 90 to 100%. Seven studies demonstrated that ASL could identify nidal location and size as well as catheter angiography, while five studies showed relatively poorer performance in delineating venous drainage. Two studies showed 100% sensitivity of ASL in the identification of residual or obliterated AVMs following stereotactic radiosurgery. CONCLUSIONS Despite limitations in the current evidence base and technical challenges, this review suggests that ASL has a promising role in the work-up and post-treatment follow-up of AVMs. Larger scale prospective studies assessing the diagnostic performance of ASL are warranted. ADVANCES IN KNOWLEDGE ASL demonstrates overall validity in the evaluation of intracranial AVMs.
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Affiliation(s)
- Sanjeev Ramachandran
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Deyashini Mukherjee
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Jonathan Delf
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
| | - Matthew James Bown
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Neghal Kandiyil
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
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